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Fri Oct 12 03:57:19 BST 2007

Ok, K, et al,here is a common scenario from the highways and byways of the Wheat State:

Pick your age and gender, in a high speed crash with an hr (+/-) transport time.  Hits the door with a low BP, tachycardia, pale...you know, shock.  Roll him/her into the bay?  Yes?  NO?  ICU? OR?  How do you know?  Pelvis? Chest? Abd?

Ok, I'd whisk him to....the EC trauma bay.  It's a "Level I" at our house.  No residents.  Mid-levels and a trauma attending, blood bank, lab, rad with US and a upper level to read it (not that I won't anyway) and an SICU R.N.

Chest and pelvis is taken and up in ....oh, 3 to 5 minutes from when they hit the door (that's most of K's time gone)...and the pt has bilat pneumos and an openbook pelvis fx...where to now?  OR?  ICU?

I guess I'd put chest tubes in and, more or less simultaneously, sheet wrap the pelvis.  I wouldn't worry about lines yet...our bays are hot so we're doing our best to not let the triad get too far ahead.  Now where?  ICU?  Angio?  I'd go to ICU now..we have to call angio in so I don't want him to go to x-ray to sit and get cold, not to mention in a hole where there is little help, access and supplies.  

Is this what my colleagues would do or am I incompetent?  And, under the best circumstances you won't get bilat chest tubes and a sheet wrap on in 3 more minutes (at least not where I work)...maybe we're...a....little....slow...up...here....

So my "Mattox 8-max-minutes" are long gone.  Does it make a difference?  No.  Do speedy helicopters save lives of trauma patients?  No...probably not in the civilian setting.

Now I have a relatively stable pt...we can get him to the SICU, put a foley in...get some lines in...get a lactate or blood gas to see how far behind we are....

Is this an honest assessment of how "we do it"? Yes.  Absolutely.

Are we doing it wrong?  I don't think so.  There are a million scenarios we could go thru...the question was posed for a "seriously injured patient".  NO specifics.  I gave you "a seriously injured patient".  How would ya'll do it?

RD

> From: KMATTOX at aol.com> Date: Thu, 11 Oct 2007 21:17:23 -0400> To: trauma-list at trauma.org> Subject: Re: ideal ER lengths of stay?> > > In a message dated 10/11/2007 8:11:09 P.M. Central Daylight Time, > roydanks at hotmail.com writes:> > we'll sometimes put lines in, in the bay and "stabilize" so that the move to > the ICU is safer...you know, so lines don't get pulled, tubes are in > well...etc.> > > > > One has to ask what it is that one can do in the EC in such a patient, that > cannot be done 3-5 minutes later in the OR or the ICU. > > Portable Chest X-ray, maybe> CT in highly selected patients, maybe> > Fluids - NO do it in the OR if any> NG tube - NO do it in the OR or ICU> Foley - Same same. do it in OR or ICU> Chest tube, Maybe, but that is why I gave up to 5-8 minutes initially.> > The purpose of an EC in the described patient is to wave to them as they go > from the ambulance dock to the OR or the ICU. > > k> > > > ************************************** See what's new at http://www.aol.com> --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/
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ideal ER lengths of stay?